INTRODUCTION:Post-stroke depression (PSD) frequently occurs after acute stroke and negatively affects rehabilitation. Dopamine has beneficial effects on motivation and emotional stability. In stroke patients, low dopamine levels are linked to PSD. This study investigated whether levodopa treatment during in-hospital rehabilitation impacts PSD compared to placebo. PATIENTS AND METHODS:ESTREL-Depression was a pre-planned analysis of the multicenter, randomized, double-blind, placebo-controlled ESTREL trial. Participants with an acute ischemic or hemorrhagic stroke were randomly assigned to receive either levodopa/carbidopa (100/25 mg) or placebo three times daily for 39 days. All ESTREL participants with (1) information about the presence or absence of depression at three months and (2) who took at least 80% of the study medication were eligible for the study. Participants with a history of depression were excluded. For the primary outcome, the presence of PSD was defined as having a T-score of ≥55 in the Patient-Reported Outcomes Measurement Information System short-form depression-4a 3 months after randomization. Binary logistic regression was performed to assess the effect of levodopa on PSD. RESULTS:The study included 407 ESTREL participants (median age 72, 60% male), 209 receiving levodopa, and 198 receiving placebo. At 3 months, the frequency and odds of PSD did not differ between the levodopa group (26%) and the placebo group (28%) (OR = 0.93, 95% CI, 0.60-1.43). CONCLUSION:In the ESTREL-Depression study, treatment with levodopa had no impact on the occurrence of PSD. CLINICAL TRIAL REGISTRATION:ClinicalTrials.gov: NCT03735901 (https://clinicaltrials.gov/study/NCT03735901).
INTRODUCTION:Levodopa did not enhance early motor recovery at 3 months after stroke in the Enhancement of Stroke Rehabilitation with Levodopa (ESTREL) trial. However, whether levodopa modifies the time course of recovery, leading to a delayed benefit remains unclear. Here, we examined levodopa's effects on the trajectories of motor recovery up to 6 months after stroke. PATIENTS AND METHODS:The ESTREL trial, a double-blind, randomised controlled clinical trial, compared a 39-day regimen of levodopa/carbidopa (100 mg/25 mg, 3×/day) to placebo alongside standardised task-oriented training. We longitudinally analysed Fugl-Meyer Motor Assessment (FMA) total scores (primary outcome), mRS and NIHSS (secondary outcomes) at baseline (0-7 days post stroke), 5 weeks, 3 and 6 months using linear mixed-effects models including timepoint, treatment allocation and their interaction. RESULTS:In total, 576 of 610 (94%) participants (median age 73 years; 40% female) were analysed. FMA scores improved over time in both groups (P < .001), with no overall levodopa effect across visits (estimate 0.65 points, 95% CI, -3.3 to 4.6; P = .75). There was no indication that levodopa modified the recovery trajectory (χ2 = 0.52, df = 3, P = .91), and estimated levodopa-placebo differences in FMA changes across visit intervals were small, ranging from -0.7 to +0.8 points, with confidence intervals crossing zero. Secondary outcomes showed similar longitudinal improvement, without evidence of a treatment effect. CONCLUSION:In this post hoc analysis of ESTREL participants with repeated FMA assessments, motor impairment improved from the first days after stroke up to 6 months. Levodopa added to task-oriented inpatient rehabilitation did not improve motor recovery or alter its trajectory over this period. CLINICAL TRIAL REGISTRATION:NCT03735901, available at ClinicalTrials.gov: https://clinicaltrials.gov/study/NCT03735901?cond=NCT03735901&rank=1.
IntroductionPsychophysiological research increasingly recognizes the multidimensional nature of subjective experiences such as fatigue and their relevance for autonomic regulation. However, little is known about how different dimensions of fatigue are associated with changes in core cardio-respiratory variables in clinical populations. This longitudinal study aimed to investigate the associations between three dimensions of fatigue – physical, cognitive, and emotional – and core physiological variables in post-COVID-19 patients. Physiological variables were collected during both daytime and nighttime periods to examine the individual and combined effects of fatigue dimensions.MethodsTo this end, thirty post-COVID-19 patients (male: 11, female: 19, age: 44.1 ± 12.7 years) participated in the study during their 29.6 ± 10.2 days stay in a rehabilitation clinic. Four times a day, they reported their fatigue level using a mobile app. Physiological variables, i.e., electrocardiogram (ECG), respiratory rate, and blood oxygen saturation were recorded continuously via wearable sensors during at least 2 monitoring weeks that were 2 weeks apart. Linear mixed models were used to assess associations between daily averages of each fatigue dimension and physiological variables, adjusted for potential confounders.ResultsThe interaction of multiple fatigue dimensions demonstrated more consistent associations with physiological changes than single dimensions independently. Daily changes in fatigue were associated with fluctuations in physiological variables, particularly during sleep. Specifically, daily changes in resting heart rate (P < .01), sample entropy of RR intervals (P = .04), and LF peak frequency (P = .047), as well as overnight changes in LF/HF ratio (P = .046) and sample entropy of RR intervals (P < .001), showed significant linear associations with changes in the interaction among fatigue dimensions. Patterns suggest a shift toward sympathetic dominance with higher physical fatigue, and a shift toward parasympathetic dominance with increases in both cognitive and emotional fatigue. Additional trends (adjusted P < .10) supported the interpretation that interaction effects between fatigue components play a critical role in autonomic dynamics.DiscussionThis study highlights the importance of investigating fatigue as a multidimensional construct in this patient group, enhancing understanding of its relationship with autonomic regulation and supporting more personalized approaches to monitoring and managing fatigue in post-COVID-19 patients.
Introduction: Songlines for Parkinson’s is a group-based, music-and-movement intervention co-developed with people with Parkinson’s (PwP) and a multidisciplinary team of scientists and practitioners for use in community settings (Rose et al., 2025). Three trials have been conducted in Switzerland and the UK demonstrating its effects on motor and non-motor symptoms. This study aimed to evaluate the application of Songlines within outpatient clinical settings in Switzerland (Köchli et al., 2025). Methods: The Songlines program was adapted for two clinical settings to evaluate its feasibility and impact. Study 1 focused on program development and comparison with a Gentle Gym program, while Study 2 assessed its implementation in an independent clinic. Pre- and post-intervention assessments included motor outcomes (e.g., MDS-UPDRS, 6-Minute Walk) and non-motor outcomes (e.g., HADS, PDQ-8). Acceptability and participant experience were further explored through qualitative methods and the Theory-Informed Intervention Acceptability Questionnaire. Results: In Study 1 (Gentle Gym n = 5; Songlines n = 6), mixed-effect models indicated post-intervention improvements in Romberg ratio (p = .021), reduced variability in stride length (p = .001), and increased stride velocity (p = .012) in both groups. In Study 2 (n = 6), Timed Up and Go performance (p = .042) and vividness of auditory imagery (p = .048) improved. Participants reported increased use of music for emotional regulation, and program acceptability was rated high (M = 4.5 [out of 5]). Discussion/Conclusion: Together, these two studies provide converging evidence that Songlines is a promising, flexible, and highly engaging intervention that can be delivered in a group setting, yet individualized according to patient needs. The program improves balance, gait stability, functional mobility and subjective wellbeing. Future research should develop sustainable models to expand access to this non-pharmacological, group-based intervention. References Rose, C.D., Ungerer, M., Köchli, S., Paolantonio, P., Dinacci, D., Foletti, A., Molteni, D., Greenwood, A., Thomas, M., Truran, L., Annett, L. E., Karageorghis, C. I., Whyatt, C., Poliakoff, E., & Short, A. (2025). Songlines for Parkinson’s: The process of co-developing a new music-and-movement group-based intervention to improve mood and movement for Parkinson’s. International Journal of Qualitative Methods, 24, Article 16094069251335453. https://doi.org/10.1177/16094069251335453 Köchli, S., Stadelmann, M., Senn, O., Paolantonio, P., Galati, S., Dinacci, D., Foletti, A., Trost, W., Bujan, B., Mylius, V., & Rose, C.D. (2025). Clinical adaptation of a novel co-developed music-and movement based intervention for people with Parkinson’s: A mixed methods feasibility study. Journal of Novel Physiotherapies, under review.
Geriatric rehabilitation (GR) is a key component of integrated care for older adults. This study aims to outline the current state of geriatric rehabilitation in the DACH region, highlighting national differences, comparing structural frameworks, and assessing the implementation of the European consensus statement and WHO recommendations. An online survey was conducted within a working group of GR experts from the three countries, officially nominated by the national geriatric societies. The questionnaire was developed based on a search of recent literature on the GR process and supplemented by desktop research on country-specific care structures based on the European Consensus Statement on GR. The most significant structural difference relates to Austria, where phase 2 rehabilitation for older patients is offered only in disease-oriented centers, but no service is currently available for specific GR. All three countries use different standardized admission assessments, therapy minutes and country-specific geriatric qualifications. Digital health solutions and mobile/home-based GR are still in development. The recommendations of the European Consensus Statement are largely adopted, with country variations. In order to ensure the evidence-based long-term effectiveness, quality and sustainability of GR, there is a need for standardized quality criteria and innovative models. Such models will facilitate the identification of best practices grounded in robust evidence and focused on optimizing care. In light of these considerations, further research in this field is needed. Key Summary Points. This article aims to present the current state of GR in the DACH region, in order to detect differences, compare the national structures and to show the extent to which the European Consensus Statement and WHO recommendations have been implemented. The most significant structural differences relate to the absence of specific phase 2 GR in Austria, different standardized admission assessments, therapy minutes and country-specific geriatric qualifications. Mobile/home-based GR as well as digital health solutions are still in development. Future considerations for GR should include the development of standardized quality criteria and the integration of innovative models, particularly in mobile and home-based settings, to ensure long-term effectiveness, evidence-based quality, and sustainability.
